What is Celiac Disease?

Celiac disease is a digestive disease found in the small intestine which interferes with the absorption of nutrients from food.  This genetic disorder affects at least 1 in 133 Americans. The consumption of a protein, called gluten, triggers an autoimmune response that causes damage to the small intestine. Gluten is found in wheat, rye, barley, as well as some oats. Related proteins are found in triticale, spelt, kamut. It is important to note that the autoimmune response is NOT found in the proteins of corn and rice.
When people with celiac disease consumes foods or uses products containing gluten, their immune system produces antibodies which damages or destroys villi—the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person can become malnourished due to the inability to absorb adequate nutrients.  

Symptoms of Celiac disease can occur at any age and varies from person to person:
    • Abdominal bloating or pain
    • Vomiting
    • Diarrhea
    • Constipation
    • Pale, foul-smelling, or fatty stool
    • Weight loss or weight gain
    • Lactose intolerance

Non digestive symptoms include:
Fatigue, bone or joint pain, unexplained iron-deficiency anemia, arthritis, osteoporosis, depression or anxiety, numbness in hand and feet, seizures, irregular menstruation, infertility or recurrent miscarriage, hair loss, mouth sores, or dermatitis herpetiformis (an itchy skin rash).

Some specific symptoms in children include:
Irritability, failure to thrive, delayed growth or short stature, delayed puberty, and dental enamel defects of permanent teeth.

TESTING FOR CELIAC DISEASE
If celiac disease is suspected, the health care provider will order a set of antibody blood tests such as tTGA, AGA, DGP or EMA. Genetic testing of the blood is also available to help determine who may be at risk for celiac disease.

If the tests are positive, upper endoscopy is usually performed to sample a piece of tissue (biopsy) from the first part of the small intestine (duodenum). The biopsy may show a flattening of the villi in the parts of the intestine below the duodenum.
Other lab tests may help determine the severity of the disease and the extent of the complications a person may experience:

• CBC to look for anemia
• CRP to evaluate inflammation
• CMP to determine protein and calcium levels, and to verify the status of the kidney and liver
• Vitamin D, B12, and folate to measure vitamin deficiencies
• Iron, Transferrin, and Ferritin to detect iron deficiency
• Stool fat to help determine malabsorption
• Lactose intolerance and allergy testing since those with celiac disease may also experience additional food allergies or intolerances

A follow-up biopsy or blood test may be ordered several months after the diagnosis and treatment. These tests evaluate your response to treatment. Normal results mean that you have responded to treatment, which confirms the diagnosis. However, this does not mean that the disease has been cured.

TREATMENT
The only known treatment at this time is strict adherence to a gluten-free lifestyle. It is best to work with a Registered Dietitian on a gluten-free diet plan to learn how to read ingredient lists and identify foods that contain gluten in order to make informed decisions at the grocery store and when eating out.

For most people, following a gluten free diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvement begins within days of starting the diet. The small intestine usually heals in 3 to 6 months in children but may take several years in adults. A healed intestine means a person now has villi that can absorb nutrients from food into the bloodstream. This diet is a life-long change and will need to be continually followed. Eating even a small amount of gluten can damage the small intestine. The damage will occur in anyone with the disease, including people without noticeable symptoms. Depending on a person's age at diagnosis, some problems will not improve, such as short stature and dental enamel defects.

If no improvement is seen on the gluten free diet, the most common reason is that small amounts of gluten are still being consumed. Hidden sources of gluten include additives such as modified food starch, preservatives, and stabilizers made with wheat. And because many corn and rice products are produced in factories that also manufacture wheat products, they can be contaminated with wheat gluten. A Registered Dietitian will help you decipher your intake and find any hidden sources of gluten you may be ingesting.

Our goal at MetroWest Medical Center is to provide treatment, support and resources to those diagnosed and living with Celiac Disease. The Metro West Celiac Support Group is designed to link those living with Celiac Disease to the available resources and medical care in order to lead a successful gluten-free life style.  As a member of our MetroWest Community you will be connected to the best medical care available.  By attending our Celiac Support Group you will have access to those already living with the disease, experts in the field, and resources to help you navigate your way through the supermarket, restaurant and your kitchen.